BMJ Open Quality最新文献

{"title":"Targeting insulin stacking to address overnight hypoglycaemia in hospitalised patients with diabetes.","authors":"Priyanka Moolchandani, Satya Patel, Tyler Larsen, Christopher Moriates, Jane Weinreb, Estelle Everett","doi":"10.1136/bmjoq-2024-003178","DOIUrl":"10.1136/bmjoq-2024-003178","url":null,"abstract":"<p><p>Inpatient hypoglycaemia is a significant concern in patients with diabetes due to its association with increased mortality. At the Veterans Affairs Greater Los Angeles Healthcare System, we developed a project to reduce overnight hypoglycaemia in hospitalised patients with diabetes by addressing insulin stacking, defined as insulin dosed within 4 hours of each other. By delaying the timing of bedtime correctional insulin administration in the electronic health record, we achieved a 28% reduction in the proportion of patients experiencing insulin stacking after one year. This led to significant decreases in overnight hypoglycaemia.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitioning from night to day transplants: changing the transplant culture for optimisation through a province-wide quality improvement initiative.","authors":"Lucas Streith, Sean Keenan, Subin Punnen, Heidi Butler, Eric Lun, Andrew Sawka, John Yee, Vinay Dhingra, Steve Reynolds, Kenneth Ryan, Brian Yang, Ron Carere, Peter Kim","doi":"10.1136/bmjoq-2024-003164","DOIUrl":"10.1136/bmjoq-2024-003164","url":null,"abstract":"<p><strong>Background: </strong>Organ transplants, some of the most complex operations, have historically been performed overnight due to logistical challenges in healthcare systems. Overnight transplants contribute to transplant team burnout and can compromise patient outcomes. A province-wide quality improvement (QI) initiative was launched to increase the daytime operation rate to ≥80%.</p><p><strong>Methods: </strong>The project was launched in July 2020 by the Daytime Transplant Working Group, including stakeholders from the Organ Donation Organization, donor hospitals, and the two recipient hospitals to increase daytime transplants, as defined by operation start time between 07:00 and 14:00 for donor operations and 08:00 and 18:00 for recipient operations. Organ donor and recipient operation start times were collected from January 2019 to June 2020 (control period), July 2020 to December 2021 (intervention period) and January 2022 to December 2023 (maintenance period). Data were analysed using p-charts on SQCpack V.7 (PQ Systems, Dayton, OH).</p><p><strong>Results: </strong>From 696 retrieval operations, a total of 458 liver transplants, 295 lung transplants, 126 heart transplants and 1122 kidney transplants were performed. Our ≥80% target was met for liver, lung, and heart transplants; however, there was no change in kidney transplants. Daytime rates of organ donor operations increased but did not achieve the ≥80% target.</p><p><strong>Interpretation: </strong>Despite the COVID-19 pandemic impacting OR access during the intervention period, the target of ≥80% daytime operations was achieved for liver, lung and heart transplants by engaging donor and recipient hospitals. The transition to daytime surgery was improved with a dedicated team to systematically address barriers and concerns from donor hospitals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving screening rates for sexually transmitted and blood-borne infections among patients initiating care in a low-barrier addiction medicine clinic: a quality improvement project.","authors":"Geneviève Kerkerian, Enrique Fernandez Ruiz, Cole Stanley, Rachelle Funaro, Emma Jean Thorson Mitchell, Julia Kirsten MacIsaac","doi":"10.1136/bmjoq-2024-003088","DOIUrl":"10.1136/bmjoq-2024-003088","url":null,"abstract":"<p><p>Despite a high prevalence of sexually transmitted and blood-borne infections (STBBIs) among patients with substance use disorders, screening rates in addiction medicine settings are often low. At baseline in our addiction clinic, only 65% of patients were offered screening and only 6% completed screening blood work. This quality improvement project aimed to improve the rate of STBBI screening among new intakes in our clinic by 50%.Interventions included the creation of clinic screening guidelines to include annual screening for all patients for HIV, hepatitis B and C, syphilis, gonorrhoea and chlamydia. Additionally, an on-site phlebotomist was hired. These interventions increased screening rates to an average of 33% with the greatest improvement seen after the addition of the phlebotomist. We found that implementing a bundle of interventions improved rates of screening and detection of STBBIs in a low-barrier addiction medicine clinic. Comprehensive infection prevention, screening and linkage-to-treatment protocols are needed to close gaps in care for this vulnerable patient population.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital versus postdischarge 30-day mortality in patients admitted after acute myocardial infarction (AMI), cerebral stroke or hip fracture: a cohort study based on registry data.","authors":"Jon Petter Blixt, Doris Tove Kristoffersen, Jon Helgeland, Christian Thoresen, Paul P Aylin, Ole Tjomsland","doi":"10.1136/bmjoq-2024-003030","DOIUrl":"10.1136/bmjoq-2024-003030","url":null,"abstract":"<p><strong>Background: </strong>30-day mortality is frequently used to monitor and improve patient safety and quality of care. In this study, we compare 30-day mortality according to place of death, that is, during admission (in-hospital), postdischarge or after readmission for patients with acute myocardial infarction (AMI), cerebral stroke and hip fracture.</p><p><strong>Methods: </strong>Administrative data for patients admitted with AMI, cerebral stroke and hip fractures to Norwegian hospitals between 2017 and 2019 were obtained from the Norwegian Patient Registry, enabling the estimation of mortality and readmission proportions.</p><p><strong>Results: </strong>A total of 84 212 admissions with AMI (38%), cerebral stroke (32%) and hip fracture (30%) were included. 30-day mortality was 9.2% for patients admitted with AMI, 11.4% for stroke and 8.7% for hip fractures. Among these, a substantial proportion died after discharge from their initial hospital stay with 23.4% of the deaths following AMI, 32.8% for stroke and 59.0% for hip fracture, respectively.</p><p><strong>Conclusion: </strong>This study demonstrates a substantial proportion of 30-day mortality following AMI, stroke and hip fractures occurring postdischarge, emphasising the importance of monitoring outcomes beyond hospital stays. Mortality patterns varied by age, length of stay and comorbidity burden, indicating a need for tailored postdischarge strategies, particularly for older adults and patients with complex health conditions. We believe that the findings may indicate a need for targeted interventions and follow-up care to improve outcomes for high-risk groups. Further research is recommended to refine these strategies and enhance patient care across healthcare settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating multifaceted strategies to prevent nasoenteral tube complications and achieve significant cost savings in critically ill patients: the ENHANCE-CRIT trial.","authors":"Fernanda Antunes Ribeiro, Lidiane Soares Sodré da Costa, Aline Cristina Pedroso, Priscila Barsanti de Paula Nogueira, Simone Brandi, Diogo Oliveira Toledo, Claudia Regina Laselva, Daniel Tavares Malheiro, João Manoel Silva","doi":"10.1136/bmjoq-2024-003177","DOIUrl":"10.1136/bmjoq-2024-003177","url":null,"abstract":"<p><strong>Background: </strong>Nasoenteral tube (NET) use is common in critically ill patients but is associated with significant complications, including accidental dislodgement, malpositioning in the bronchial tree or mechanical failures, which can impede nutritional therapy. These complications often lead to adverse events that increase hospital stay, costs, and patient morbidity.</p><p><strong>Objective: </strong>This study aimed to reduce complications related to the placement and maintenance of NETs in critically ill patients using multifaceted strategies.</p><p><strong>Methods: </strong>We conducted an observational cohort study between February 2022 and March 2023 using the Institute for Healthcare Improvement's (IHI) Model for Improvement. Data were collected from electronic forms, and process indicators were analysed for adequacy of tube fixation and complication rates. The study compared preintervention data to outcomes following five strategies: nasal bridle fixation, staff training, integration of a decision-support tool, restructuring of the NET care plan and practical simulation-based training.</p><p><strong>Results: </strong>After implementing the interventions, complications related to NET decreased from 41% to 28%, preventing 200 adverse events. This reduction led to an improvement in patient outcomes, including a shorter hospital stay by 10 days on average, freeing up a total of 6520 bed days. The intervention not only reduced complications but also optimised hospital resource utilisation. An economic analysis revealed total savings of US$95 208, demonstrating both clinical efficacy and financial benefits.</p><p><strong>Conclusion: </strong>The multifaceted strategies significantly reduced NET-related complications, improved patient outcomes, and enhanced resource efficiency in critical care settings. These interventions demonstrated substantial cost-effectiveness, underscoring the value of structured, preventive measures in improving patient safety and reducing healthcare costs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Service-level interventions to reduce waiting time in outpatient and community health settings may be sustained: a systematic review.","authors":"Kim Manderson, Nicholas F Taylor, Annie Lewis, Katherine E Harding","doi":"10.1136/bmjoq-2024-003235","DOIUrl":"10.1136/bmjoq-2024-003235","url":null,"abstract":"<p><strong>Aim: </strong>The primary aim of this systematic review of the literature was to determine whether interventions to reduce waiting time in outpatient and community health services can be sustained. The secondary aim was to describe associations between sustainability and features of waiting time interventions and the settings in which they have been implemented.</p><p><strong>Methods: </strong>CINAHL, Medline, Embase and Psych Info databases were searched, combining the search concepts 'waiting time or waiting lists', 'outpatient or community care' and 'sustainability'. Studies were included if they tested a service-level intervention that aimed to reduce waiting in an outpatient or community setting and reported data with a minimum 12-month follow-up period. Data were extracted and analysed using a descriptive synthesis. Methodological quality was evaluated using the mixed-methods appraisal tool (MMAT). Waiting interventions were rated as sustained, partially sustained or not sustained using predetermined criteria. The Grading of Recommendation, Assessment, Development and Evaluation was used to describe certainty of evidence for different intervention approaches.</p><p><strong>Results: </strong>Screening of 7770 studies yielded 22 papers investigating the sustainability of waiting interventions for approximately 150 000 clients. Many were of lesser quality, with 14 not meeting more than 3 of 5 criteria on the MMAT checklist. Intervention types were categorised as referral entry, open access and substitution, used either alone or in combination. There was low certainty evidence that all interventions were associated with sustained reductions in waiting time, often with large effect sizes, but the findings are limited by low methodological quality of many studies and the risk of publication bias.</p><p><strong>Conclusion: </strong>Reductions in wait times and waiting lists for health services can be achieved and sustained following interventions, but further high-quality research would better inform service providers about what interventions are most effective and provide the greatest return on investment.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety culture through the perspectives of healthcare workers: a longitudinal study in a private healthcare network in Brazil.","authors":"Helidea de Oliveira Lima, Leopoldo Muniz da Silva, Ana Claudia Lopes Fernandes de Araújo, Vanessa de Melo Silva Torres, Leandro Reis Tavares, Deborah Simões, Saullo Queiroz Silveira, Anthony Mh Ho, Glenio B Mizubuti, Joaquim Edson Vieira","doi":"10.1136/bmjoq-2024-003020","DOIUrl":"10.1136/bmjoq-2024-003020","url":null,"abstract":"<p><strong>Background: </strong>Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure and a steadfast commitment to ensuring its safety and stability over time.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the temporal trend of patient safety culture according to the perception of professionals working in a private healthcare network in Brazil over a 7-year period (2015-2022).</p><p><strong>Methods: </strong>The Hospital Survey on Patient Safety Culture questionnaire was distributed to 34 hospitals between 2015 and 2022 with 160 607 responders. A linear mixed-effects regression model was applied to fit the trend for the dimension score over time.</p><p><strong>Results: </strong>Out of the 12 measured dimensions in the HSOPSC Survey, 8 showed significant improvement over a 7-year period (p<0.05). The dimensions of communication openness (p=0.22), non-punitive response to errors (p=0.08), staffing (p=0.06) and the frequency of reported events (p=0.22) have not demonstrated improvement over time. Management support for patient safety and organisational learning received positive responses from at least 75% of those surveyed in 2022, earning the distinction as 'strong areas of patient safety'. Comparing 2015 and 2022, the proportion of participants who rated their unit/work area on patient safety as 'fair' or 'good' decreased, while the proportion of participants who considered it 'very good' increased (p<0.001).</p><p><strong>Conclusions: </strong>Findings indicate an improvement in patient safety culture from 2015 to 2022. Key challenges identified in enhancing safety culture included communication openness, staffing, frequency of reported events, and nonpunitive response to errors.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving drug charting practices and documentation among nurses in emergency department at a regional hospital, Bhutan: a quality improvement initiative.","authors":"Pema Wangmo, Sherab Wangdi, Gyem Lhamo, Jamyang Dorji, Jigme Wangmo, Nima Wangchuk, Hem Kumar Nepal","doi":"10.1136/bmjoq-2024-003188","DOIUrl":"10.1136/bmjoq-2024-003188","url":null,"abstract":"<p><strong>Introduction: </strong>Medication error is one of the most common safety issues and the highest prevalence rate of preventable medication-related harm is seen in low-income and middle-income countries especially in Africa and South Asian countries. Studies done elsewhere show that medication errors related to transcription and drug chart documentation can be as high as 70%. A baseline survey done in our department showed that our drug charting practices and documentation are only complete in 45% which could significantly contribute to medication errors and patient safety.</p><p><strong>Methods: </strong>To address this gap, our project aimed to improve the drug charting practices and documentation among nurses in our department from 45% to more than 90% in 8 weeks. We formed a team and implemented strategies through four plan-do-study-act cycles. Interventions included increasing sensitisation about hospital transcription protocol, standardising drug charts and monitoring of drug chart practice. The members meet every 2 weeks to discuss, analyse and plan for next intervention based on our findings at the end of every cycle.</p><p><strong>Results: </strong>At the end of the project, the completeness of drug chart documentation improved from 45% to 98% and adherence to standard charting practices from 51% to 98% CONCLUSION: Medication transcription error is common and improving on incomplete drug chart and poor charting practices can reduce errors. Our results emphasise the importance of simple and cost-effective intervention in bringing and achieving the aim which could be implemented in other department and institutions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication failures and racial disparities in inpatient maternity care: a qualitative content analysis of incident reports.","authors":"Rebecca Clark, Tamar Klaiman, Kathy Sliwinski, Rebecca Hamm, Emilia Flores","doi":"10.1136/bmjoq-2024-003112","DOIUrl":"10.1136/bmjoq-2024-003112","url":null,"abstract":"<p><strong>Background: </strong>Severe maternal morbidity (SMM) and mortality disproportionality affect Black women in the USA. Communication failures are a leading cause of poor maternal outcomes. We examined incident reports to identify communication failures within inpatient maternity care and racial disparities therein.</p><p><strong>Methods: </strong>We analysed de-identified incident reports submitted by hospital staff working on antepartum, labour and birth, and postpartum in an urban, academic hospital between 2019 and 2022. Reports were linked to electronic health records to capture race and SMM outcome. We conducted qualitative content analyses using a constant comparative method and an inductive and deductive approach. We explored communication failures by race/ethnicity and SMM outcome. In vivo themes included equity and positive communication.</p><p><strong>Results: </strong>We identified 541 communication failures within a random sample (n=1006) of incident reports across the study period. Black women represented 28% of births during this time, but 38% of the incident reports. Most of the communication failures occurred within the healthcare team rather than with patients. Communication failures were, broadly, contextual (eg, audience, who was present), conceptual (eg, lack of shared understanding) or sociotechnical (eg, computer-human interface). Of the incident reports coded as contextual failures, errors of omission were the most common. Most conceptual failures were a lack of shared understanding. Sociotechnical failures were predominantly workflow and communication and internal organisational features.</p><p><strong>Conclusions: </strong>Our findings suggest that if we want to address communication failures as a root cause of maternal morbidity and mortality, we need to focus on the quality of communication within the healthcare team. These efforts should concentrate on decreasing omission and building shared understanding of responsibilities and processes, especially when teams are caring for Black women.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation of a cocreation methodology to develop claims-based indicators for feedback on implementation of comparative effectiveness research results into practice.","authors":"Vera de Weerdt, Hanna Willems, Geeske Hofstra, Sjoerd Repping, Xander Koolman, Eric van der Hijden","doi":"10.1136/bmjoq-2023-002542","DOIUrl":"10.1136/bmjoq-2023-002542","url":null,"abstract":"<p><strong>Introduction: </strong>Comparative effectiveness research (CER) often fails to create quality improvement since implementation of CER results in clinical practice is lacking. Claims-based Audit & Feedback (A&F) provides a resource efficient tool to stimulate implementation, but it is unknown whether medical professionals accept claims-based A&F in the context of CER. Therefore, in this study, we developed claims-based indicators using a cocreation approach and evaluated medical professionals' perception regarding the validity and acceptability of these indicators.</p><p><strong>Methods: </strong>Between July 2019 and November 2021, we used a cocreation approach with medical experts to develop claims-based indicators for six CER trials. The aim is to use the indicators for group level feedback on implementation of CER results to medical professionals across all healthcare providers in the Netherlands. To build the indicators, we used the most recent available Dutch national healthcare-related claims data of the year 2017. The cocreation process consisted of the following steps: (1) defining the target indicator, (2) selecting relevant claims codes, (3) testing feasibility of the indicators using Dutch claims data, (4) discussing results of feasibility testing and (5) defining the final indicators and reflecting on the acceptability of the indicators for feedback on implementation of CER results by the experts.</p><p><strong>Results: </strong>Claims-based indicators could not perfectly reflect the CER population for any of the six CER trials. However, the cocreation process did lead to a final indicator that medical experts found acceptable in four of six cases. Recommendations of medical experts for improving claims-based indicators included: select patients with minimal over- or underestimation of the CER population, use proxies to identify patients, determine incidence rather than prevalence for chronic conditions and use data linkage with diagnostic test results.</p><p><strong>Conclusion: </strong>A cocreation approach was a successful way to develop claims-based indicators on implementation of CER results, which were imperfect, but in some cases still acceptable as feedback to medical experts. Thus, for certain topics, claims data may provide a resource efficient data source for A&F interventions aiming to implement CER trials.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}